Sunday, September 25, 2016

On the day that I penned this post, I rounded at our
community hospital. My first patient
was in the step-down unit, which houses patients who are too ill for the
regular hospital floor. I spoke to the
nurse in order to be briefed on my patient’s status. I learned that this nurse was assigned 6
patients to care for – an absurd patient volume for a step-down unit. “Why so many patients?” I asked. She explained that some nurses called off
work and the patients had to be spread around among the existing nurses.

This occurs every day in every hospital in the country. Nurses are routinely required to care for
more patients than they should because there is a nursing shortage on a
particular day. Why do hospital
administrators allow this to happen? If
any are reading this post, I invite your response. Enlighten us.
When a nurse is overburdened, how do you think this affects quality of
care and nursing morale?

I suppose it saves a few bucks on payroll, but this strikes
me as very short term gain that risks medical and financial consequences. Providing high quality medical care can’t be
a rushed effort. If a nurse’s job
description increases by 30%, do you think the quality of care and
patient/family satisfaction won’t decline?
Don’t administrators fear the risk of medical errors from overworked
nurses? Would any of them like to be
patients under these circumstances?

Nurses Need Help

Nurses have confided to me for years how demoralized they
are that no one speaks for them. Instead
of watching their backs, they often feel that they are stabbed in the back.

I do not have warm feelings for labor unions and I support
right to work initiatives. But, when I
see what nurses endure and the lack of support that they receive, I would
support them if they moved to organize.

If a 3rd grade teacher is ill, we expect a
substitute teacher to be called in. The
third graders are not simply herded into another classroom expecting one teacher
to handle a double load.

Many of us today are asked to do more with less. Teachers, law enforcement, businessmen and
government program administrators know this well. At some point, you aren’t cutting fat
anymore, but are slicing into bone. We are not taking proper care of those who have dedicated their lives to care for us. Who will heal the healers?

Sunday, September 18, 2016

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio.
Once of my points in that piece is that I did not want legislators
making medical decisions for us. They
can’t even do their own jobs.

I am not against medical marijuana; I am for science. The currency of determining the safety and
efficacy of a medicine should be medical evidence, not faith, hope or belief.

Marijuana is a Drug Enforcement Agency (DEA) Schedule 1
drug, alongside heroin, LSD and Ecstasy.
I realize this seems odd since most of us do not believe that marijuana
has the health or addictive risks of the other agents on the list. It doesn’t.
But, danger is not the only criteria used in determining which category
a drug belongs in, a point often misunderstood or ignored by medical marijuana
enthusiasts. An important criterion of Schedule 1 drugs is that they are
deemed to have no proven medical use.

The federal government recently affirmed marijuana’s
Schedule 1 status, which disappointed those who argue that this agent is the
panacea, or at least an effective treatment, for dozens of ailments. The government disagreed. It reviewed several hundred medical studies
and only identified 11 of them that were of sufficient scientific quality
worthy of consideration. None of them
demonstrated a salutary effect of marijuana.

DEA Holds Firm

An advocate of medical marijuana use was railing against
this decision and stated that 80% of Americans believed marijuana had medical value. His point demonstrates
the vacuousness of his argument. He
might support letting polling determine if a drug is safe and effective; but I
trust the FDA and hard science to make these determinations.

I am sure that if we polled the public on the medical
benefits of probiotics, gluten restriction, GMO foods, organic foods, radiated foods, colonic
detoxification, yoga, veganism and meditation that we might find that the
public’s belief in these practices doesn’t have firm scientific support. I do not argue that these dietary and
lifestyle practices do not have health benefits or enhance life in other ways,
only that they are either unproven or disproven. There are still folks out there who believe
that the measles vaccine causes autism, even though this theory has been
thoroughly debunked. In my view, releasing a medicine to market requires firm
scientific support. Anecdotes and low
quality ‘studies’ should be afforded the weight they deserve.

Should we open up the gates to all kinds of potions and
elixirs that are unproven for the public?
We do! They are called dietary
supplements. These agents are considered
safe until they are proven to be dangerous.
Is this the standard we want for prescription drugs?

Sunday, September 11, 2016

I work with nurses every day. Anyone who doesn’t realize how hard these
professionals work, has never been in a hospital. Their job descriptions have expanded along
with their work load. This is not your
father’s hospital ward. Hospitalized
patients today are older and sicker than ever before. It takes a seasoned nursing professional to
manage the care of these complex patients.
Their work days are full simply managing the expected tasks of
dispensing medications, coordinating diagnostic tests and assessing their
patients. There is no time scheduled for
unexpected events, which are expected as sick people’s conditions may change at
any moment. In other words, if a nurse
must attend immediately to a patient with chest pain, then his or her other more
mundane tasks are delayed or shifted over to another busy nurse.

I believe that the most potent barrier that is separating
nurses from their patients today is the ferocious documentationmandates that nurses are required to
perform. The hospital corridors are
clogged with nurses hovering over computers entering all kinds of data, most of
which will never be viewed by physicians.
These nurses are not techies who want to be palpating a keyboard. They are compassionate caregivers who want to
be in their patients’ rooms caring for them.

Tomorrow's Nurse?

If you suspect that I am exaggerating here, then go ask a
nurse.

Moreover, the hospital’s electronic medical record system
has become deeply layered and complex. Often I can’t find the specific data I
need. Just last week, a couple of senior
nurses and I were scouring through the computer to find a patient’s result of
stool testing for blood. We simply
couldn’t find it, and these nurses are pros.
At that point we were left with the following options:

Reorder the test

Make up the result

Quit the profession and become an Uber driver

Ask the patient what the result was

Hire a 12-year-old who could find the results in a few
seconds.

While the computer record is packed with data concerning
every aspect of the patient's medical experience, I have my own approach to
find out what’s going on. Pay close
attention here. Read the next sentence very
slowly as I want readers to grasp the complex process I use each day as I
approach the nurse.

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About Me

I am a full time practicing physician and writer. I write about the joys and challenges of medical practice including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When I'm not writing, I'm performing colonoscopies.